Below you will find all of the necessary forms for your monthly documentation. If you have any problems using these forms, please contact
Julie Clark.
Please Note: Centerstone forms are available in Word or Adobe format. The Word documents can be typed on and saved with your information. The Adobe Acrobat files are “fillable forms” and can be typed on if you so choose however they can not be saved. You can print them after you type the information and it will print what you recorded or you can print blank copies and write the information by hand. The DCS documents from their website (Med Log and Med Services Form) change from time to time so we put up direct links to those forms.
Online Documentation EMS (KaleidaCare)
Access KaleidaCare by clicking here.
Centerstone Forms
Monthly Billing Invoice [Family Cover Sheet]
One per household. This form is to include information on ALL children in your home for the month. This serves as your billing invoice and replaces the monthly calendars
Individual Child Daily Notes
Do one of these for EACH CHILD in your home. This form is to be used as an ongoing narrative describing the daily activities of each child in your home. Activities need to be recorded daily if possible and should refer to goals of their treatment plan.
Verification Sheet
Do one of these for EACH CHILD in your home. This form verifies that a child received their allowance and clothing allotment, participated in a fire drill, and documents if and when they saw their DCS worker during the past month. Children must sign / initial the form showing that they were given allowance and clothing money.
DCS Forms
Prescription Medication Log
Prescription Medication Log must be turned in on any child who takes any kind of medication.
Health Services Confirmation
This is to be filled out ONLY when a child goes for any medical, dental, or psychiatric service.
Re-evaluation Information
Is your re-evaluation approaching? Click here for information.
